Permit t
CITY TIGARD SEWER CONNECTION PERMIT
41 DEVELOPMENT SERVICES PERMIT #: SWR2003 -00391
c � J � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/19/03
SITE ADDRESS; 12282 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300
SUBDIVISION: - ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: PIZZA SCHMIZZA
USA NO: FIXTURE UNITS: 23
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.4 EDU increase. Capping 12 fixture units, adding 35 for a net total of 23 fixtures units or 1.4
EDU's.
Owner:
FEES
BPP RETAIL LLC
BY BURNHAM PACIFIC PROPERTIES Description Date Amount
ATTN: JOHN WATERS [SWUSA] Swr Connect 11/19/03 $3,360.00
SAN DIEGO, CA 92101 [SWUSA] Swr Connect 11/19/03 $0.00
Phone:
Total $3,360.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
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I ued by: , r ��I lj- � ,
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l� Permittee Signatu / �j
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally Parcel # /$/3 Vi . DOgOQ
Tenant Name: Pizza Schizza This SWRt2003 -00391
Site Address: 12282 SW Scholls This PLM# 2003 -00584
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 1 4 1 4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 3 15 3 15
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 1 1 1 1
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 • 0 0 0 0
- Commercial 3 0 3 9 4 12 1 3
- Service 3 0 1 3 1 3 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 _ 0 4 _ 12 10 35 6 23
Current Fixture Value 23 divided by 16 = 1.4 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 23 divided by 16 = 1.4 over (under) $ 3,360.00
Enter EDU Change Here 1.4
Notes: _______________
Na me: � . _ ' %� _ - 4�i Date: // / %4
Bui • ng Division
Note: The property owner shall retain this record for sewer credit purposes. In the event of a credit, this
document stamped "ORIGINAL" shall serve as a credit voucher and must be submitted to the City of
Tigard Building Division to redeem credit towards future system development charges.